Risk of Major Cardiovascular Events and All-Cause Death in Patients with Bronchiectasis and Associated Resistance to Antimicrobial Drugs

Tommaso Bucci; Ran Guo; Kai-Hang Yiu; Gregory Y H Lip; Freddy Frost

doi:10.1093/eurjpc/zwaf122

Risk of Major Cardiovascular Events and All-Cause Death in Patients with Bronchiectasis and Associated Resistance to Antimicrobial Drugs

Eur J Prev Cardiol. 2025 Mar 4:zwaf122. doi: 10.1093/eurjpc/zwaf122. Online ahead of print.

Authors

Tommaso Bucci^{1

2}, Ran Guo^{3

4}, Kai-Hang Yiu^{3

4}, Gregory Y H Lip^{1

5

6}, Freddy Frost^{1

7}

Affiliations

¹ Liverpool Centre for Cardiovascular Science at University of Liverpool, Liverpool John Moores University and Liverpool and Heart and Chest Hospital, Liverpool, United Kingdom.
² Department of Clinical Internal, Anesthesiologic and Cardiovascular Sciences, Sapienza University of Rome, Rome, Italy.
³ Cardiology Division, Department of Medicine, The University of Hong Kong, Hong Kong, China.
⁴ Division of Cardiology, Department of Medicine, The University of Hong Kong Shen Zhen Hospital, Shen Zhen, China.
⁵ Danish Center for Health Services Research, Department of Clinical Medicine, Aalborg University, Denmark.
⁶ Department of Cardiology, Lipidology and Internal Medicine, Medical University of Bialystok, Bialystok, Poland.
⁷ Respiratory Department, Liverpool Heart & Chest Hospital NHS Foundation Trust, Liverpool, UK.

PMID: 40037796
DOI: 10.1093/eurjpc/zwaf122

Abstract

Aim: To assess the impact of antimicrobial resistance (AMR) on major adverse cardiovascular event (MACE) risk in patients with bronchiectasis.

Methods: This retrospective study utilized data from the TriNetX research network, analysing patients with bronchiectasis categorized by the presence or absence of AMR. Primary outcomes included the risk of MACE (myocardial infarction, stroke and systemic thromboembolism, and cardiac arrest) and all-cause death. Cox regression analysis with 1:1 propensity score matching (PSM) was applied to estimate hazard ratios (HR) and 95% confidence intervals (CI) for the primary outcomes. Subgroup analyses were conducted to validate results in clinically relevant subgroups.

Results: Prior to PSM, patients with AMR (n=6,543, 61.0±22.0 years, 55.8% female) were younger, more often male, and presented a higher prevalence of cardiovascular risk factors than those without AMR (n=154,685, 67.3±16.0 years, 59.4% female). After PSM, no significant differences were found between groups. However, AMR patients showed a higher risk of MACE (HR 1.29, 95% CI 1.17-1.41) and all-cause death (HR 1.49, 95% CI 1.38-1.61) compared to non-AMR patients. The MACE risk was notably elevated among AMR patients without prior cardiovascular events (HR 1.56, 95% CI 1.34-1.81). Similar MACE risks were observed in cystic fibrosis (HR 1.24, 95% CI 0.86-1.78) and non-cystic fibrosis subgroups (HR 1.28, 95% CI 1.16-1.41), with consistent findings across different AMR types.

Conclusions: In patients with bronchiectasis, AMR is associated with an increased risk of MACE and all-cause death, suggesting that controlling AMR spread may confer broader health benefits, particularly in reducing cardiovascular risk.

Keywords: bronchiectasis; cardiovascular event; resistance to antimicrobial drugs.

Plain language summary

In this study, we hypothesized that the proinflammatory state associated with bronchiectasis may be exacerbated by the onset of antimicrobial drug resistance, thereby increasing cardiovascular risk.Patients with bronchiectasis and antimicrobial drug resistance are at a high risk of major adverse cardiovascular events and all-cause death.The increased risk of adverse events appears to be independent of age, sex, the presence of cystic fibrosis or autoimmune diseases, and the specific type of antimicrobial drug resistance.